Breast reconstruction helps restore the appearance of the breast. It is an option for many women after a mastectomy. Breast reconstruction is rarely done after breast-conserving surgery (BCS) because most women do not notice a significant difference in their breast after this type of surgery. It is occasionally done after BCS if there is a significant defect.

Breast reconstruction often involves more than one operation. Surgery may be required on the unaffected breast so that is matches the reconstructed breast.

The decision to have surgery for breast reconstruction or to use a breast prosthesis is a personal one. It is based on the woman’s desires, lifestyle and physical or medical limitations. Women choose to have breast reconstruction to:

The timing of surgery for breast reconstruction depends on the type of treatment the woman receives, as well as her personal preferences.

Immediate reconstruction is done at the same time as the surgery to remove the cancer. It may be possible to have immediate breast reconstruction if it does not interfere with other treatments for breast cancer, such as chemotherapy or radiation therapy.

Delayed reconstruction is done after adjuvant therapyadjuvant therapyTreatment given in addition to the first-line therapy (the first or standard treatment) to help reduce the risk of a disease (such as cancer) coming back (recurring). for breast cancer is finished.

The results are the same regardless of whether the breast reconstruction is done immediately after breast cancer surgery or at a later time.

For most women, it is possible to have breast reconstruction before or after chemotherapy, radiation therapy or both. Breast reconstruction should be delayed 3–4 weeks after chemotherapy and 4–6 weeks after radiation therapy.

Immediate versus delayed breast reconstruction

Timing of breast reconstruction

Advantages

Disadvantages

Immediate reconstruction

May mean less emotional stress as the woman does not have to deal with not having a breast.

Requires coordination between the surgeon who removes the breast cancer and the plastic or reconstructive surgeon who reconstructs the breast.

Avoids an extra operation and may be more convenient.

Requires a longer operation.

Breast tissue is not altered by radiation therapy or scarred from previous surgery.

May not be possible if breast tumour is very large.

Delayed reconstruction

Allows the wound to completely heal, particularly if the woman will be getting radiation treatment.

Increases the number of separate surgeries needed, such as the mastectomy, breast reconstruction and possible nipple reconstruction.

Gives the woman a chance to recover from one operation before having another one.

Allows the woman to focus on treating the cancer and then decide on reconstruction at a later time.

Allows the woman and her doctor to prepare for the surgery and choose the best option.

There are a number of breast reconstruction methods. Women considering breast reconstruction should talk to their surgeon about the different techniques to find the one that will be the most suitable.

Breast implants

A breast implant is an outer shell of rubberized silicone filled with saline (sterile salt water) or silicone gel. Most commonly, surgery to place a breast implant is done in 2 stages:

A temporary tissue expander is placed first, to create a pocket of tissue.

The permanent implant is placed at a later date, when the expander has created space for the implant.

Autologous breast reconstruction

Autologous breast reconstruction uses the woman’s own body tissues (muscle and fat) that are collected from other parts of her body to create a new breast. The different types of tissue techniques used for breast reconstruction are:

Nipple and areola reconstruction

Women can usually wear a bra once the wound (incision) has completely healed. They should follow the advice of the surgeon about exercise and when to return to normal activities.

It may take several months for tissue to heal after breast reconstruction. There are often scars, which fade over time but may never go away entirely. A reconstructed breast will not look exactly like the original breast. The other natural breast may have to be reshaped or resized to match the reconstructed breast.

A reconstructed breast will not have normal breast feeling (sensation). This is because a nerve that runs through the deep breast tissue and supplies feeling to the nipple often gets cut during surgery. Over time, the skin on the reconstructed breast regains some sensitivity, but the breast will not have the same feeling as before.

Breast reconstruction after breast cancer surgery is covered by most provincial health insurance plans, but the amount and type of coverage vary across Canada. Check your provincial health insurance plan before having breast reconstruction.